Planocellular cancer of a neck of a uterus
Planocellular cancer of a neck of a uterus – the malignant neoplasia which is formed of the cages of a flat epithelium getting various degree of an atipiya. Planocellular cancer of a neck of a uterus can carry a "mute" current. In clinically expressed cases it is shown by bloody allocations, belyam of different character, at the started onkoprotsess – pains in the field of a basin, dysfunction of a bladder and rectum. Pathology is diagnosed according to vaginal survey, FATHERS tests, a kolposkopiya, a biopsy, determination of level of an onkomarker of SCC in blood. Methods of treatment of planocellular RShM - surgical interventions (a uterus neck konization, a trakhelektomiya, a hysterectomy), himioluchevy therapy.
Planocellular cancer of a neck of a uterus
Planocellular cancer of a neck of a uterus – a histologic kind of the tservikalny cancer coming from the multilayered flat epithelium covering a vaginal part of a neck of a uterus. In structure of invasive RShM this histologic type is diagnosed in 70-80% of cases, in 10-20% the uterus neck adenocarcinoma, in 10% - the low-differentiated cancer meets, other malignant tumors of a neck of a uterus make less than 1%. The maximum incidence of planocellular cancer of a neck of a uterus is the share of women at the age of 40-60 years. The long period of a "mute" current leads to the fact that over 35% of cases of planocellular cancer of neck of a uterus are diagnosed already in the started stage that exerts negative impact on the forecast and an outcome of a disease. Development of strategy of prevention and carrying out mass screening of female population on RShM are priority problems of practical gynecology and oncology.
Reasons of planocellular cancer of neck of a uterus
The unambiguous causes of planocellular cancer of neck of a uterus are not defined, however at the present stage the factors starting process of a malignization of a multilayered flat epithelium are rather well studied. First of all, the virus of papilloma of the person (HPV), mainly 16 and 18 types belongs to such factors, is more rare - 31 and 33 types. In most cases at planocellular cancer of a neck of a uterus HPV-16 is identified. Among other virus agents, sexually transmitted, the virus of simple herpes of the II type, a cytomegalovirus, etc. can play a role of oncogenes. Serve as background processes at which planocellular cancer of a neck of a uterus can develop further an erosion, , the polyp of the tservikalny channel, a leukoplakia, tservitsit, etc.
Besides, cellular regeneration is promoted also by other factors: hormonal frustration, smoking, reception of immunosupressor (glucocorticosteroids, tsitostatik), immunodeficiency. A certain negative role is played by a uterus neck travmatization at repeated childbirth, installation of Naval Forces, performing surgeries: abortions, diagnostic vyskablivaniye, diatermokoagulyation and diatermokonization and so forth. The women who early began sexual life, who are often changing sexual partners, neglecting methods of barrier contraception, transferred STD enter into risk group on developing of planocellular cancer of neck of a uterus.
Classification of planocellular cancer of neck of a uterus
In the considered histologic type allocate planocellular with an orogoveniye and planocellular without RShM orogoveniye. In the microscopic relation planocellular orogovevayushchy cancer of a neck of a uterus differs in existence of signs of a keratinization of cages – "cancer pearls" and keratogialinovy granules. Epitelialny cages abnormally large, pleomorfny, with uneven contours. Mitotic figures are presented poorly. In medicines of neorogovevayushchy planocellular cancer of neck of a uterus there are no keratin "pearls". Cancer cells mainly large, polygonal or oval form. Their high mitotic activity is noted. Degree of a differentiation of RShM can be high, moderate or low.
Taking into account the direction of tumoral growth distinguish the ekzofitny, endofitny and mixed forms of planocellular cancer of neck of a uterus. The ulcer and infiltrative form is characteristic of the started RShM stages; usually it is formed at disintegration and a necrosis endofitno of the growing tumor.
RShM passes four clinical stages in the development. Also allocate a zero, or initial stage (vnutriepitelialny cancer) at which only cages of an integumentary epithelium without invasion in a basal plate are surprised. The first stage is subdivided into two periods: microinvasive cancer with a penetration depth in Strom to 3 mm (a stage 1A) and invasive cancer with an invasion more than 3 mm (a stage 1B). Distribution of tumoral process on a uterus body is a sign of the second stage. The third stage of RShM is characterized by germination of a tumor in a small pelvis; at a sdavleniye or an obturation of a mochetochnik develops . During the fourth stage the invasion in a rectum and a sacrum, disintegration of a tumor, emergence of the remote metastasises is noted.
Symptoms of planocellular cancer of neck of a uterus
In zero and 1A of a stage clinical manifestations of RShM, as a rule, are absent. During this period diagnosis of planocellular cancer of neck of a uterus is possible during planned inspection at the gynecologist. Further, in process of deepening of an invasion and expansive growth of a tumor the characteristic pathological triad appears: bleach, bleedings and a pain syndrome. Allocations from a genital tract can have various character: to be serous transparent or with blood impurity (in the form of "meat slops"). In case of accession of an infection or disintegration of tumoral knot bleach can gain muddy, putreform character and a fetid smell.
Bleeding from a genital tract at planocellular cancer of a neck of a uterus differ with the intensity – from the smearing allocations to acyclic or menopausal bleedings. More often bleedings have a contact origin and are provoked by gynecologic survey, sexual intercourse, syringing, a natuzhivaniye at defecation.
The pain syndrome at planocellular cancer of a neck of a uterus can also carry various expressiveness and localization (in a waist, a sacrum, a crotch). As a rule, it testifies to neglect of an onkoprotsess, germination of parametralny cellulose and defeat of lumbar, sacral or coccygeal nervous textures. At germination of cancer in the next bodies dizurichesky frustration, locks, formation of urinogenital fistulas can be noted. In a terminal stage cancer intoxication and a kakheksiya develops.
Diagnosis of planocellular cancer of neck of a uterus
Clinically "mute" forms of planocellular cancer of neck of a uterus can be found when carrying out a kolposkopiya or by results of cytologic FATHERS dabs. An important role in diagnostics is played by carefully collected gynecologic anamnesis (the number of sexual partners, childbirth, abortions transferred STD), and also detection of vysokoonkogenny strains of VPCh in the studied scrape by PTsR method.
At survey in mirrors planocellular cancer of a neck of a uterus is defined in the form of papillomatozny or polipovidny growth or ulcer education. Edofitny tumors deform a uterus neck, giving it the barrel-shaped form. At contact the new growth bleeds. For definition of a stage of an oncological disease and an exception of metastasises to bodies of a small pelvis it is conducted two-handled vaginal and vaginal a research. In all cases of detection of pathologically changed uterus neck the expanded kolposkopiya, dab fence on an onkotsitologiya, an aim biopsy and a scraping of the tservikalny channel without fail is carried out. For morphological confirmation of the diagnosis and scrape go to a histologic research.
Determination of the SCC level (marker of planocellular cancer) in blood serum has a certain informational content. As the methods of the specifying diagnosis of planocellular cancer of neck of a uterus designed to estimate degree of prevalence of a neoplasia and to help with the choice of an optimum method of treatment of the patient serve transvaginal ultrasonography, KT or MPT of a small pelvis, excretory urography, a X-ray analysis of lungs, a tsistoskopiya, a rektoromanoskopiya.
Treatment of planocellular cancer of neck of a uterus
At planocellular cancer of a neck of a uterus the surgical, beam, chemotherapeutic and combined treatment can be used. The choice of this or that method or their combinations is defined by prevalence and morphological type of a tumor, and also age and reproductive plans of the patient.
At stages 0 – IA at patients of childbearing age is carried out a konization or amputation of a neck of a uterus. At IB-II stages the optimum volume of intervention - the hysterectomy with the top third of a vagina, sometimes is required carrying out neoadjyuvantny chemotherapy; in a postmenopause pan-hysterectomy - removal of a uterus with an adneksektomiya is shown. At the III-IV stages of planocellular cancer of neck of a uterus the standard is himioluchevy therapy (beam treatment + cisplatinum), however some authors allow a potential possibility of expeditious treatment. At defeat of mocheotvodyashchy ways performing stenting of a mochetochnik can be required.
In functionally inoperable cases caused by associated diseases intracavitary radiation therapy is appointed. At a recurrence of RShM performance of an ekzenteration of a small pelvis, performing palliative himioluchevy and symptomatic therapy is shown.
Forecast and prevention
Upon termination of treatment dynamic observation of the patient is made quarterly within the first 2 years, and then times in half a year to 5-year term. If planocellular cancer of a neck of a uterus is found at a zero stage, then in due time carried out treatment gives chances of nearly 100% recovery. The percent of bezretsidivny five-year survival at RShM I of a stage makes 85%, the II stages – 75%, III - less than 40%. At the IV stage of a disease it is possible to speak only about extension of life, but not treatment. Cancer of a stump of a neck of a uterus develops less than at 5% of patients.
Prevention of planocellular cancer of neck of a uterus consists in carrying out mass and regular cytologic screening of female population, medical examination of the women having background and precancer diseases of a neck of a uterus. A big preventive role is played by refusal of smoking, the prevention of STD and carrying out preventive vaccination against RShM at teenage age.